Frequently Asked Questions
Light Duty is when an employer finds work within an injured workers restrictions. If your employer can find work within your doctors restrictions, then the employer can have the injured worker work and it also allows them a reduction in their insurance rates. The issues we see the most with light duty are that some employers do not follow the doctors restrictions and sometimes ignore them completely. The other common complaint with Light Duty is that it is "useless" such as being paid to watch TV. The bottom line is, if an employer offers medically appropriate Light Duty and the injured worker refuses, then it is a reason for denying benefits for time off work. If the Light Duty is not medically appropriate, an injured worker should discuss the issue immediately with the Insurance Adjuster to see if it can be resolved short of benefits being denied due to noncooperation with Light Duty.
Independent Medical Exam - IME
The Workers Compensation Carrier will likely set up an "Independent Medical Exam". This is an appointment with a doctor paid by the insurance carrier. Please note, it is not "Independent" in any sense of the word. It should state, "Insurance Medical Exam". These exams are just one more tool for the insurance companies to use to deny or limit claims. Unfortunately, Utah law does allow the insurance company to do this kind of exam with very few limits. But the limits that do exist are that they must give the injured worker adequate notice and they are only usually allowed to do one per claim. Please note that refusing to attend these exams is grounds for a denial of the claim based on "non-cooperation".
Release Forms for Medical Records and Medical Providers
Under Utah law the Workers Compensation carrier has an opportunity to investigate claims. This includes looking at previous medical records, both for the industrial injury and any previous injuries. It also includes things like family physicians. The Workers Compensation Carrier then is likely to send a "Request to Release Medical Records" as well as "Medical Care Provider list. The first one allows them to get medical records from your providers. The second tells them who those providers are. Please note, prior to litigation they can only ask for a ten year history. Once litigation is filed it becomes 15 years. Many clients are , understandably, hesitant to release this information. However, failure to disclose this information will likely result in a denial of the claim until this information is provided.
Duty to Report the Accident or Injury
If you have a work injury, you should report it immediately. Many people are hesitant to report injuries for various reasons. However, if you do not report it, it can not be documented. Not only will this raise issues to trying to prove the claim, it also gives rise to credibility issues once the claim is raised. There is no case where not reporting the accident or injury would be helpful. Please report it immediately. If your employer will not report it, please contact the Utah Labor Commission (link). They can help you report it and if necessary help you contact the appropriate Workers Compensation carrier.
Use Your Health Insurance
Many people ask about the interaction regarding workers compensation and their individual private health care. The bottom line is if you are being denied workers compensation benefits and you need treatment,and you have private health care, is use it! The most important part of every claim is getting our clients back to work or getting the care they need. If the workers compensation carrier will not pay for treatment do the following: 1. List the workers compensation carrier as the primary insurance on the paperwork. 2. List your private health care as the secondary carrier on the paperwork. 3. Get the recommended treatment. What this achieves is that the workers compensation carrier gets notice of the medical bill, but your private health care will pay it until you can straighten it out with or without legal help. We handle many cases every year involving private health care companies and are more than happy to work together with them to make sure the Workers Compensation Carriers pay the amounts they are responsible for.